New Study Shows Progress in Determining Why Multiple Sclerosis Patients’ Symptoms Worsen Despite High-Efficacy Treatment

April 25, 2024
Cells called microglia in the brain, which are likely partially to blame, can be identified with a new imaging technique.

A new study from Brigham and Women’s Hospital suggests a way to determine the cause of worsening symptoms in patients with multiple sclerosis (MS) who are receiving highly effective treatments, as reported by the hospital.

Positron emission tomography (PET) brain scans “could reveal hidden inflammation” in these patients not picked up by a routine MRI. Lead author Tarun Singhal, MD, MBBS, began to notice that patients “who were being treated with the most effective MS treatments available were experiencing worsening symptoms.” The research team has worked to develop an “approach of imaging cells called microglia,” which are “immune cells in the brain that are thought to have a role in MS disease progression.” The team eventually developed something called F18 PBR 06 PET imaging, which “involves the injection of a tracer, or dye, that binds to the microglia cells.”

Rohit Bakshi, MD, one of the paper’s co-authors, said that “increased microglial activity means more atrophy of gray matter in the brain,” leading to affected “cognition, movement, [and] fine motor skills.”

The study ended up showing that “the damage to patients’ brains correlated with the disability and fatigue levels they were experiencing.” Researchers also learned that patients being treated with “low-efficacy treatments had more abnormalities on their PET scans, suggesting more microglial cell activation” compared to those receiving high-efficacy treatments. However, the fact that those receiving high-efficacy treatments still showed some PET abnormality suggests that “residual inflammation despite treatment” could “account for future worsening and progression.”